Nurses’ ballot initiative would set patient limit

GREENFIELD — The Massachusetts Nurses Association, which represents nurses at hospitals across the state including Baystate Franklin Medical Center, has filed a ballot initiative that would set a limit for the number of patients a nurse is assigned to at any given time.

The initiative, which wouldn’t see legislative action or a spot on the state ballot until sometime next year, if at all, would limit a medical-surgical nurse to serving no more than four patients at once. These limits would attempt to establish “safer staffing levels” and would vary slightly in number for other types of nurses who work in a hospital, according to the nurses association.

The association said that in some hospitals across the state, nurses are sometimes assigned to as many as eight patients at once, which they said can result in mistakes, serious complications or patient readmissions.

But a Baystate Health official countered that the changes would be unnecessary, adding that Massachusetts already has the best health care in the country and that these nurse-to-patient limits would cost the state hundreds of millions of dollars to implement without any real improvement.

Under the nurses association’s proposal, hospitals would be fined $25,000 for each day they fail to follow the nurse-to-patient limits.

The issue has been debated among Massachusetts legislators for years but never made into law. California is the only state that has nurse-to-patient ratio limits.

Without a law, the state’s hospitals are forcing nurses to ration care and placing patients’ health in jeopardy, argued Donna Kelly-Williams, president of the nurses association.

“This ballot measure will ensure patients receive the care they need and deserve, when they need it, preventing thousands of patient complications, saving hundreds of lives, and yes, saving millions of dollars that are being wasted now because patients aren’t receiving adequate, timely care from their nurse,” she said, in a prepared statement.

Steven Bradley, vice president of government and community relations and public affairs at Baystate Health, said that the nurses association has been trying unsuccessfully for a decade to get legislators on board with their proposal. This is the first time the nurses have tried the ballot-initiative approach.

“The most knowledgeable health care experts in the Legislature, the people who have implemented health care reform ... have determined along with colleagues that this is bad public policy, that it’s a waste of money,” said Bradley.

He argued that if there were unsafe staffing levels at hospital, then the state’s department of public health would have already shut those units down.

Sen. Stanley Rosenberg, D-Amherst, said he supported a Senate bill a few years ago that would have focused on identifying staffing problems that may exist in certain hospitals rather than imposing across-the-board restrictions. But the bill never became law.

Local nurses union representatives said that the situation is slightly better at Baystate Franklin than other non-unionized hospitals in the state. But it can still be inconsistent, with nurses sometimes asked to work at unsafe limits, they said.

Linda Judd, a medical-surgical nurse at Baystate Franklin and co-leader of the local union, said that she typically receives four to five patient assignments to begin their shift. But as the shift progresses, that number will constantly go up or down, she said.

“I would say most nurses feel four is manageable,” said Judd. “(With five or more), you’re getting more stressed, you’ve got more to juggle. ... That’s a whole lot of information, a lot of care, a lot of drugs that you’re going to be dispensing.”

The current staffing levels also don’t account for any emergencies that may occur that bring in an increased number of patients, said local union co-leader Donna Stern.

Baystate Franklin Chief Nursing Officer Deborah Palmeri said that staffing is a complex issue and patients’ needs are always the hospital’s top concern.

“To make sure we have the appropriate resources on any given unit, we consider the acuity of each patient — how sick they are and how much care they need,” she said. “We then match their needs to the skill and experience of the nurses and others on our care team. ‘One-size-fits-all’ staffing is therefore not in the best interest of our patients.”

Ballot initiative process

The nurses association has filed the petition, with 10 signatures, including one from Stern, to the state’s attorney general. But this is just the first step in a long process.

Throughout this fall, the nurses association must collect nearly 69,000 signatures from state residents, including no more than 25 percent from any one county. Stern said that every nurse will be asked to do their part to help gather signatures for the effort.

At the beginning of 2014, the state Legislature will receive all certified petitions and then have four months to act.

If no action is taken by May 1, then an additional 11,500 signatures will need to be collected for the petition to be included on the November 2014 state ballot.

If that happens, and if state residents vote in favor of it, then the initiative will become law.